Sunday, March 16, 2008

Veterans Healthcare

. . . [O]ne day the United States military will leave Iraq when we do all we have to show for it is thousands of dead Americans. In the meantime. the war ends every single day for our soldiers because someone is discharged from the United States military every single day. They're discharged with no assistance into the VA system. Some people are discharged without knowing that they qualify for veterans benefits, like I was. And with that statement said, I'm going to move into my testimony. I'm going to briefly cover something that happened while I was on active duty which, as many people know, many people are told to join the military that you will receive healthcare, your family will receive healthcare, your dependents will receive healthcare and no one can take that healthcare away from you. September 2005, I was on a training operation, deployed out of Jacksonville, Florida. We were under way. My wife was pregnant with my unborn child. While I was on that training operation, my wife began the horrible process of a miscarriage. Being home by herself, the first thing she did was to try to call the Tri-Care hotline. Tri-Care is the health service that's provided to us in the military. The lady on the hotline told her that she probably already had lost her child and that there was nothing they could do. She asked for an ambulance and she was told that, if she had $1500, they were willing to send an ambulance. Not having $1500 on the salary of an E4, she chose not to get the ambulance and she called a friend of mine and waited for him to come pick her up at our apartment and drove her to base. There's a hospital on Naval Station Mayport, it's called Hospital at Naval Station Mayport, and she arrived there at four p.m. She went inside and the nurse told her they were closing at 4:30 and they couldn't help her. She insisted to see a doctor. The doctor told her that they could not help her and she was turned away. And she once again waited in the parking lot while she was bleeding for my friend to take her to another hospital 23 miles away called the Hospital at NAS Jacksonville. No ambulance was provided. Nothing. No assistance. And we lost the child.

That's Zollie Goodman testifying on Friday at Iraq Veterans Against the War's Winter Soldier Investigation for the panel on The Crisis in Veterans' Healthcare. It's a horrible story to share and too many live through it. Of the limited coverage the hearings are thus far receiving, a great deal has focused on the Rules of Engagement panels. Those were important panels addressing code of conduct and what actually happens. We're guessing that Racism and War: the Dehumanization of the Enemy panels on Saturday will garner attention as well. It was in those panels that testimony was given on the abuse of prisoners, that Michael Leduc testified to the heads of corpses being used as targets to 'sharpen' the rifle sights, that Geoff Millard testified about how far up the chain the racism went with the h-word being bandied about all the way up through General George Casey and it's when Camilo Mejia testified.

"You remove the humanity from them," Camilo Mejia explained, "to basically repress them, to beat them; and doing so, you remove the humanity from yourself." He addressed the "blank spaces" -- where you block out what you don't want to remember How you "erase certain memories that are too overwhelming, too painful to deal with." . He shared of a child next to his headless father who had been decapitated by US machine gun fire and how he remembers it later, back on the base, "because people told me later that was the man's son."

Every hearing has had it revelations and importance. But the limited coverage thus far doesn't seem too focused on the healthcare. This is a huge issue and one of those window-of-time issues. That's due to the fact that people can actually respond to the issues of veterans healthcare right now.

After the illegal war ends? A lot aren't going to care. That's the way it was after Vietnam, after WII and, truly, after every war ends. When a war ends, especially an unpopular (and illegal) one, the society just wants to put it behind. They don't want to address it or be reminded of it. If changes are to take place to improve the veterans healthcare system, they will have to take place before the Iraq War ends.

Denial and fatigue will set in with the population and the attitude will be, "Didn't we already deal with that? I'm sick of talking about the war." It happens every cycle. Going back to the days of George Washington, promises are never kept. The government's obligations to soldiers are never met. And, in fact, after the Iraq War finally ends, you will hear gas bags -- many who claim to give a damn right now -- make that point and make it to justify not focusing on the topic. "That always happens," they will sigh and quickly move onto whatever the 'hot' topic of the day is. Ask Vietnam veterans how long they have been fighting for the limited health benefits they do have today.

So if the issue is going to be addressed, it has to be addressed while the war continues. You have the best hope of shoving sanctimonious words back in the faces of politicians and forcing them to act while people are paying attention and they fear looking like hypocrites.

That's reality.


During Friday's hearing, Eli Wright declared, "Those of you in the military know how much they love to get out of Motrin." Motrin are ibuprofen tablets and it's a sad reality that this is the cure-all for the military. If confronted with a medical issue, dispense the easiest (and cheapest) thing and get them moving along.

Also testifying on Friday was veteran Adrienne Kinne who shared that after she left the military (the second time) and finished college, she worked as a research assistant at a VA in Georgia where they were doing a study on PTSD (Post Traumatic Stress Disorder) and TBI (Traumatic Brain Injury). From that research, a screening for TBI was created. (PTSD and TBI are considered signature wounds of the Iraq War.) The group was eager to implement it and begin screening soldiers. What happened next tells you a great deal about the realities of veterans' healthcare.

Adrienne Kinne: And then they went to go to the next step, to actually make this happen. And I was actually on a conference call when someone said, "Wait a second. We can't start this screening process. Do you know that if we start screening for TBI there will be tens of thousands of soldiers who will screen positive and we do not have the resources available that would allow us to take care of these people so we cannot do the screening." And their rationale was that medically, medical ethics say if you know someone has a problem, you have to treat them. So since they didn't have the resources to treat them, they didn't want to know about the problem.

So a screening was developed that would identify service members in need of help but, because it was cheaper to do nothing, it was never implemented.

Thursday morning the US House Committee on Veterans' Affairs' subcommittee on Oversight and Investigations held a hearing entitled "Care of Seriously Wounded After In-Patient Care." They had witnesses, they took testimony.

US House Rep Harry Mitchell, the chair of the committee, explained in his opening remarks, "We are here today to hear from veterans, their families, and the Department of Veterans Affairs about the long-term care of our most severely wounded Afghanistan and Iraq veterans. We know that DoD and VA provide the excellent inpatient healthcare for these warriors. But many of the most seriously injured require extensive outpatient care, some of them for life. Their families need care and assistance as well. Unfortunately, once these veterans leave the hospital, the care they receive does not seem to be on par with what they received directly following their injury. I think we can do better."

Veteran Casey Owens testified as did Sarah Wade, wife of veteran Ted Wade. Owens lost both legs as a result of serving in Iraq and he criticized the VA's "learning curve" asking, " It has been thirty years since the last major war and what lessons has the VA learned since then? Did no one expect another war or learn anything from Viet Nam? What have the educated and highly paid personnel who have been appointed to correct the system been focusing their attention on? While the system continues to be broken, where is all the government funding going that is supposed to be fixing the system and what are they doing with?"

He also criticized the long process that required months of waiting for treatment, a complaint expressed by Friday's IVAW panel as well. Sarah Wade noted the lack of updated therapies as well, declaring, "Much of his treatement was by trial and error, as there was no model system of care for a patient like Ted, and there still is no long-term model today. His situation was an enormous challenge, as Walter Reed was only able to rehabilitate an amputee, not a TBI, the VA was able to nominally treat a TBI, but not an above elbow amputee, and neither were staffed to provide appropriate behavioral health care for a patient with a severe TBI. Because Ted could not access the necessary services, where and and when he needed them, he suffered a significant setback in 2005, that put him in the hospital for two weeks, and would take a year to rebound from."

If you caught the hearing, you got a good look into one problem with the system via Dr. Madhulika Agarwal (Chief Patient Care Services Officer of the Veterans Health Administration) who had no answers for treatment or training but did want to brag that there was an online resource created. As US House Rep Mitchell had to point out to her, there are "people who don't access the website, people who can't access the website."

But a website is cheap, easy and, best of all, no one has to be bothered, right? Because surely the answer to veterans today is less and less contact with an actual human being, right?

Tuesday, the Senate Committee on Veterans Affairs held a hearing and Senator Richard Burr, commenting on the families of veterans, declared, "My assessment is the VA doesn't see the human face behind the patients they're treating." And a website isn't going to let them see anyone any clearer. Websites and toll free lines are apparently the cost-cutting measures the White House wants implemented. They even want to remove the pharmacist from the equation as was noted Wednesday in the US House Armed Services Committee's Military Personnel Subcommittee by US House Rep Nancy Boyda (who represents some rural communities in Kansas) who questioned the rush to move towards online pharmacies for veterans to utilize. True everywhere but especially with rural communities, the pharmacist isn't just passing a sack with a prescription in it, they're a face-to-face, trained resource. And it's human contact, something that everyone needs and something that's part of any successful treatment. Instead, these cost-cutting measures seem to be attempting to turn wounded veterans into shut-ins. Call this number, visit this website, get your prescriptions delivered! Just don't bother us!

Out of sight out of mind?

Jeffrey Lucey would have benefited from a system that had time for him. Instead the veteran killed himself. His parents (Kevin and Joyce Lucey) testified on Friday's panel with his mother noting, "Unfortunately the tragedy is not that it just happened to one Marine but that this continues to happen to others four years after our son's death to countless others -- names that will never be placed on a memorial wall, "

Joyce and Kevin Lucey have suffered a tremendous loss and getting up in front of people and discussing it isn't always the easiest thing to do. Doing it keeps the memory of their son alive but they could do that with friends and families as well. Doing it in public, participating in Winter Soldier, is something they do to prevent any other veteran from falling through the cracks.

The system is broken. And it's not being repaired.

The White House has cut corners and underfunded. It's why so many veterans are complaining about their ratings. The ratings of their disabilities are confusing and intended to be so, not giving accurate ratings reduces the cost the government has to pay out on health care. It's why Zollie Goodman wasn't informed, when he discharged, that he qualified for veterans benefits. It's why Adrienne Kinee saw such a marked difference in her two discharges. When she left the military in 1998, they were very helpful, explaining what she had access to, going over forms with her, even filling them out. When she left in 2003, it had changed significantly with no one having the time to address any of it and even getting a physical become a huge ordeal.

"We all know," Kinne stated Friday, "that there is that crucial time when a soldier is leaving the military when you have that opportunity to get them in the VA system and if you miss that opportunity its just so much harder to get them in afterwards."

But when cutting costs is your 'priority,' you really aren't concerned with that.

When your real interest isn't in living up to your promise of healthcare, you don't tell Goodman or Eric Estenzo that they qualify for treatment.

Friday, Eric Estenzo testified about his back injury received in Iraq and the PTSD he suffers from. Keeping a civilian job was difficult due to both disabilities and so was re-adjusting to civilian life. (We fear someone in the White House is hollering, "Quick, create a website so we can say we dealt with it!") He ended up homeless. He was house surfing. One day, he came across Friend-to Friend feeding the homeless and he was hungry so, as a goof, he thought he'd get in line and get some food.

But then, he continued, "I looked at myself and I started thinking to myself that I am now an Iraq vet, I am standing in line with homeless people, being served free food, and this is actually happening to me, this is actually happening to our Iraq War vets and I am one of them. And I am a casualty of the system." That was it for him, he "literally cracked the day after that . . . my dignity, self-respect and my honor just went down. I was in a very dark place for a considerable amount of time."

The road back wasn't a website. It wasn't an automated number. It was contact with other veterans, such as Jeff Key, and receiving support that's not going to arrive in the mail.

As Kelly Dougherty noted in her testimony on Friday in the Corporate Pillaging and Military Contractors hearing, the illegal war's not a money pit for everyone, corporations are raking in the dough. KBR had a sweetheart deal and made big bucks. It put the soldiers like Doughterty at risk but corners can always be cut when you're talking human lives, right?

The government sent US service members into war. They did so with a promise that they would be taken care of, that their families would be taken care of. There has been little evidence that there was ever any intention to keep that promise. Testimonies offered examples of even the basic protective devices (whether it was body armor or Humvees properly equipped) not being present on the battlefield. Dougherty testified to living in Kuwait in a KBR tent city for four weeks after finishing her deployment and awaiting her return to the US. KBR was paid to house the service members and what they were given wasn't housing, it was mold covered tents and "rickety bunk beds" -- tents that made those staying in them sick.

"There is a great need for 'Whole Family' Education and resources," Jackie McMichael explained to the Senate Committee on Veterans Affairs Thursday. "Educating the Vets on the importance of a Collaborative Rehabilitation is critical. I believe many Vets see their transition as their issue alone. Mike was very resistant to me talking to his Doctors or telling me anything about what he was working on. This is understandable as I am very aware of HIPAA regulations and confidentiality. But I was losing my husband and I was seeing things I knew they could not have been aware of. I called his doctors and told them 'You don't have to say anything about Mike, just listen to me. This is what I am seeing at home.' All I wanted was to know what to look for, what to expect, what to do, how to help."

In past wars, this issue was dismissed. Jacki McMichael is married to veteran Michael McMichael who returned from Iraq and suffers migraines, hallucinations, poor memory, "hand and body tremors," PTSD and requires a cane to walk.

She pointed out that, "None of these events happened to Mike alone. They happened to me, to my 6 year old son, my 4 year old son, Mike's mom and to my parents and my brothers. We were left to watch as Mike self destructed not knowing what to do to help him or ourselves. We had no clue what was wrong with him and he was, at time, completely uninterested in finding out himself. He said over and over again, 'I know guys who lost limbs and they are OK'."

In past wars, she might have gotten a few bits of praise thrown at her and maybe a pat on the shoulder. And that would have been considered enough. It's not enough. As she and others are pointing out, the families need to be involved in the treatment. And the families need to be receiving assistance. The primary caregiver is fighting a system that's broken and that is not encouraged to work even if it wanted to. (That's not a slap at those working in the VAs, that's noting that the White House wants to cut down on claims and refuse treatment as often as possible.)

The primary care giver cannot find the system and also hold down a regular job, interact with the veteran and still be expected to maintain sanity. The burden is being shoved off onto the family. Well, if you're going to 'outsource,' pay the worker.

Too much is being asked of veterans and their families and too damn little is being given. The issue has to be raised now because within two years of the end of the Iraq War (and the Afghanistan War), we'll all be 'weary' and wanting to put it behind us. We'll wonder why those people don't just stop asking? Didn't they already get something? Maybe not everything but who gets everything? That was __ years ago, deal with it!

Not only are they not getting what they need, they are not getting what they were promised. The government has an obligation and it must live up to it. The only time to force the issue is while the nation is at war. While the war drags on, Congress is forced to deal with veterans, politicians are concerned with how they're seen and the issue can have the nation's attention.

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